Paget's Disease of the BreastPage 2
Diagnosis of Paget's Disease
- Breast Biopsy : The definitive diagnosis of Paget's disease of the breast is by biopsy of the skin. The presence of Paget's cells in the skin when examined under a microscope in a lab is confirmatory of the condition. If the affected area is quite small, it may be completely removed - it is then called an excision biopsy.
- Swab from Nipple Discharge :If nipple discharge is present, a sample can be picked up on a swab and examined under a microscope for the presence of Paget's cells.
- Screening Mammography : Mammography is effective in identifying other underlying types of breast cancers like invasive ductal breast cancer(IDC) and invasive lobular breast cancer (ILC). Very often, DCIS may be present in the breast ducts although no symptoms of breast cancers like lumps or nipple discharge is present. Mammograms can pick up microscopic breast changes that might be associated with DCIS. These breast changes are usually due to deposits of calcium called microcalcifications.
- Diagnostic Mammography : If microcalcifications are seen on the screening mammogram, a more detailed study of the breast called diagnostic mammogram, which takes views at higher magnification and from more angles, may be needed.
- Ultrasound of the breast : Ultrasound imaging, also known as ultrasonography or sonogram, produces a picture of the internal structures of the breast and can help identify a breast mass and its characteristics. A special type of ultrasound, known as Doppler ultrasound can evaluate blood flow or lack of blood flow in any breast mass. A malignant mass will have more blood flow than normal tissue.
Treatment of Paget's disease is usually successful since spread to distant organs is slow. Surgery can cause total removal of the cancer cells. There are diferent treatment procedures depending on the size of the tumor and spread to surrounding tissues and lymph nodes,
Treatment options include:
- Surgery only- Removal of the entire breast (Mastectomy).
- Mastectomy followed by radiotherapy.
- Mastectomy with hormone therapy.
Rate of survival for Paget’s disease of the nipple depends upon the stage at which the cancer is identified.
If only the nipple tissue is affected - survival rate is 99.5%. When underlying tumors exist, survival rate is assessed by the stage and size of the tumor and how far it may have invaded.
- Stage 1 - A tumor in the breast no larger than 2 cm and cancerous cells are not present in the lymph nodes. Survival rate is 80%.
- Stage 2 - Tumor larger than 2 cm and cancer has spread to lymph nodes. Survival rate is about 70%.
- Stage 3 - Tumor larger than 5 cm and lymph nodes involved. Survival rate about 40%.
- Stage 4- Spreaad to distant organs - Survival rate 20%.
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